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We propose the politics hypothesis—i.e., the hypothesis that political forces comprise either a powerful predecessor of the social determinants of health or are essential social determinants of health themselves. We examine the hypothesis that political actors like presidents, their ideology, and institutions like the political parties they represent shape overall and race-specific health outcomes. Using census and Vital Statistics data among many other sources, we apply both theory- and data-driven statistical methods to assess the role of the president's party and the president's political ideology as predictors of overall and race-specific infant mortality in the United States, 1965–2010. We find that, net of trend, Republican presidencies and socially-conservative ideology of U.S. presidents are strongly associated with slower declines of infant mortality rates, overall and for white and black infants, compared to Democratic and socially-liberal presidents in the U.S. Approximately half (46%) of the white-black infant mortality gap, about 20,000 additional infant deaths, and most if not all the infant mortality rate gap between the U.S. and the rest of the developed world, can be attributed to the 28 years of Republican administrations during the study period. These findings are consistent with the politicization of public health and the conceptualization of politics as a powerful predecessor, in the causal chain, of the social determinants of health. Understanding the political ideological and institutional contexts in which health policies and healthcare and welfare programs are implemented, as well as how governments construct culture and social psychology, provide a more comprehensive framework for understanding and improving population patterns of disease, mortality, and entrenched racial disparities in health in the U.S.

This dissertation project addresses three observations: the degree to which researchers routinely use data collected only on survivors, ignoring that who is included in samples is pre-determined by non-random mortality; that historical mortality gaps between blacks and whites have generated a cumulative demographic contraction among blacks that constitute a non-trivial vanishing electorate; and that differences in infant mortality rates (IMRs) between blacks and whites strongly correlate with the party that controls the presidency. I used data from several sources including the Centers for Disease Control and Prevention, the Multiple Causes of Death, MIDUS, and the U.S. Census Bureau among others.Because researchers are always dealing with samples truncated by non-random mortality, paradigms in social research like the relationship between age and participation are partially spurious. I find that the effect that age exerts on participation is mediated by mortality rates linked to differences in SES because, as time progresses, low-SES individuals (i.e., low-level participants) die younger than high-SES individuals (i.e., high-level participants). I also set forth a model for the impact of racial mortality gaps on the total vote lost among blacks (1970-2004). Because the dead cannot vote or voice opinions, excess deaths exacerbate the imbalance of socio-political power, especially between blacks and whites, where health differences are most pronounced. I show that the total number of excess deaths among blacks is large enough to affect the outcome of presidential elections. And, finally, I investigate the fluctuations of national and black and white IMRs associated with the political party in power. Party differences in policy preferences lead to different results in many aspects of social development, of which health is no exception. Results show that a good portion of the comparative international underperformance of the U.S. for IMR as well as of persistent black-white disparities in IMR is related to variations imparted under Republican presidents between 1965 and 2010.

AbstractRecent research on increasing income inequality focuses on recessions' role on the income distribution and racial disparities in the United States.ObjectiveThis study expands this research by focusing on the evolution of racial income inequality during postrecession periods. We hypothesize that differential recovery trends by race and income rank during postrecession periods exacerbate between‐ and within‐race income inequality. Specifically, we examine postrecession trajectories of race‐specific weekly earnings for the bottom and top 10 percent in the U.S. weekly earnings distribution.MethodWe apply a break‐spline regression approach to quarterly weekly earnings data (2001–2018) collected from the Bureau of Labor Statistics and the Federal Reserve Bank of Saint Louis for the 2001 Recession, the Great Recession, and between‐recession periods.ResultsResults show an increase in income inequality between the bottom and top 10 percent in the weekly earnings distribution during recovery periods. For all races, the bottom 10 percent recovered from recessions slower and later than the top 10 percent. We also find that Asian Americans' weekly earnings influence between‐ and within‐race income inequality during postrecession periods.ConclusionIncome inequality—overall and across races—is entrenched as racial/ethnic minorities and the poor are particularly vulnerable to recessions and are neither catching up nor recovering during upturns of the economy.

Background Infant mortality rates in the US exceed those in all other developed countries and in many less developed countries, suggesting political factors may contribute.

AbstractObjective. This research analyzes the impact of political trust on Native American electoral participation, using survey responses from roughly 1,500 Native Americans living in South Dakota and Nevada.Method. The in‐person survey taking was conducted at locations in Native communities and with the support of tribal leaders, allowing us to overcome many of the methodological issues that have hampered previous studies.Results. We found much higher levels of electoral participation in tribal elections than in non‐tribal elections. Respondents expressed high levels of distrust in nontribal government and voting methods, and this distrust has a surprisingly powerful impact on the decision to participate in nontribal elections.Conclusion. We suggest that historical trauma and ongoing discrimination are the primary causes of distrust among Native Americans and find support for this in the observed differences in levels of trust between South Dakota and Nevada.

AbstractThere is growing evidence on the negative effects of perceived discrimination on health outcomes and their interactions with indicators of socioeconomic status. However, less has been studied on whether income and education lead individuals of a different race to encounter different discriminatory experiences in their lifetime. Using data from the national survey of the Midlife Development in the United States—MIDUS 1 (1995-1996) and MIDUS Refresher (2011-2014)—on eight measures of perceived lifetime discrimination, this study compares discriminatory experiences of Black and White persons in two time periods. We applied generalized structural equation models and generalized linear models to test multiplicative effects of income and education by race on lifetime discrimination. In both periods, we find substantive disparities between White and Black people in all types of lifetime discrimination, with Black people reporting much higher levels of discrimination. Such disparities exacerbated in the top cohorts of society, yet these associations have changed in time, with White individuals reporting increasing levels of discrimination. Results show that, for Black people in the mid-1990s, perceived discrimination increased as education and income increased. This finding persisted for education by the early 2010s; income effects changed as now both, low- and high-income Black people, reported the highest levels of discrimination. These findings highlight a policy conundrum, given that increasing income and education represent a desirable course of action to improve overall discrimination and health outcomes. Yet, we show that they may unintendingly exacerbate racial disparities in discrimination. We also show that the U.S. is moving toward a stagnation period in health outcomes improvement, with racial disparities in discrimination shrinking at the expense of a deterioration of whites' lifetime discriminatory experiences. Our results highlight the need for a multi-systems policy approach to prevent all forms of discrimination including those due to historical, institutional, legal, and sociopolitical structures.

On account of poor living conditions, African Americans in the United States experience disproportionately high rates of mortality and incarceration compared with Whites. This has profoundly diminished the number of voting-eligible African Americans in the country, costing, as of 2010, approximately 3.9 million African American men and women the right to vote and amounting to a national African American disenfranchisement rate of 13.2%. Although many disenfranchised African Americans have been stripped of voting rights by laws targeting felons and ex-felons, the majority are literally "missing" from their communities due to premature death and incarceration. Leveraging variation in gender ratios across the United States, we show that missing African Americans are concentrated in the country's Southeast and that African American disenfranchisement rates in some legislative districts lie between 20% and 40%. Despite the many successes of the Voting Rights Act and the civil rights movement, high levels of African American disenfranchisement remain a continuing feature of the American polity.

Excess mortality in marginalized populations could be both a cause and an effect of political processes. We estimate the impact of mortality differentials between blacks and whites from 1970 to 2004 on the racial composition of the electorate in the US general election of 2004 and in close statewide elections during the study period. We analyze 73 million US deaths from the Multiple Cause of Death files to calculate: (1) Total excess deaths among blacks between 1970 and 2004, (2) total hypothetical survivors to 2004, (3) the probability that survivors would have turned out to vote in 2004, (4) total black votes lost in 2004, and (5) total black votes lost by each presidential candidate. We estimate 2.7 million excess black deaths between 1970 and 2004. Of those, 1.9 million would have survived until 2004, of which over 1.7 million would have been of voting-age. We estimate that 1 million black votes were lost in 2004; of these, 900,000 votes were lost by the defeated Democratic presidential nominee. We find that many close state-level elections over the study period would likely have had different outcomes if voting age blacks had the mortality profiles of whites. US black voting rights are also eroded through felony disenfranchisement laws and other measures that dampen the voice of the US black electorate. Systematic disenfranchisement by population group yields an electorate that is unrepresentative of the full interests of the citizenry and affects the chance that elected officials have mandates to eliminate health inequality.

AbstractSocial stratification is an important mechanism of human organization that helps to explain health differences between demographic groups commonly associated with socioeconomic gradients. Individuals, or group of individuals, with similar health profiles may have had different stratification experiences. This is particularly true as social stratification is a significant non-measurable source of systematic unobservable differences in both SES indicators and health statuses of disadvantage. The goal of the present study was to expand the bulk of research that has traditionally treated socioeconomic and demographic characteristics as independent, additive influences on health by examining data from the United States. It is hypothesized that variation in an index of multi-system physiological dysregulation – allostatic load – is associated with social differentiation factors, sorting individuals with similar demographic and socioeconomic characteristics into mutually exclusive econo-demographic classes. The data were from the Longitudinal and Biomarker samples of the national Study of Midlife Development in the US (MIDUS) conducted in 1995 and 2004/2006. Latent class analyses and regression analyses revealed that physiological dysregulation linked to socioeconomic variation among black people, females and older adults are associated with forces of stratification that confound socioeconomic and demographic indicators. In the United States, racial stratification of health is intrinsically related to the degree to which black people in general, and black females in particular, as a group, share an isolated status in society. Findings present evidence that disparities in health emerge from group-differentiation processes to the degree that individuals are distinctly exposed to the ecological, political, social, economic and historical contexts in which social stratification is ingrained. Given that health policies and programmes emanate from said legal and political environments, interventions should target the structural conditions that expose different subgroups to different stress risks in the first place.

Social stratification is one important mechanism of human organization that helps to explain health differences between demographic groups commonly associated with socioeconomic gradients in the United States. Individuals, or group of individuals, with similar health profiles may have had different stratification experiences. This is particularly true as social stratification is a significant non-measurable source of systematic unobservable differences in both SES indicators and health statuses of disadvantage. Accordingly, the goal of the present analyses was to expand the bulk of research that has traditionally treated socioeconomic and demographic characteristics as independent, additive influences on health. It is hypothesized that variation in an index of multi-system physiological dysregulation—Allostatic Load—is associated with social differentiation factors, sorting individuals with similar demographic and socioeconomic characteristics into mutually exclusive econo-demographic classes. The data are from the Longitudinal and Biomarker samples of the Study of Midlife in the US (MIDUS). Latent class analyses and regression analyses reveal that physiological dysregulation linked to socioeconomic variation among black people, females, and older adults are associated with forces of stratification that confound socioeconomic and demographic indicators. In the United States, racial stratification of health is intrinsically related to the degree to which black people in general, and black females in particular—as a group—share an isolated status in society. Findings present evidence that disparities in health emerge from group-differentiation processes to the degree that individuals are distinctly exposed to the ecological, political, social, economic and historical contexts in which social stratification is ingrained. Given that health policies and programs emanate from said legal and political environments, interventions should target the structural conditions that expose different subgroups to different stress ...